- Kelly Kerksick, OD
The challenge of trying to guess whether or not a patient is interested in multifocal lenses can be very difficult. Many times patients won't verbalize with the doctor their interest or desire for contact lenses. In particular, many patients assume that the doctor will be the one to make the recommendation for contact lenses. Unfortunately, many practitioners aren't always mentioning multifocal and other specialty contact lenses to the patient as often as they should which leaves the patient to assume that they are not candidates for these amazing technologies. Doctors who are successful at upgrading patients into multifocal lenses will say the key to their success is how they, along with their staff, communicate and position the upgrade to their patients.
I make my recommendation for multifocal contact lenses upon completion of the examination. I always like to validate my recommendation with an example of why it will be better for the patient. For instance, patients who have been wearing monovision really get excited to learn that there are technologies available that will allow them to see clearly with not just one eye, but with both eyes in the distance and up close. One of the points that I like to mention is that multifocals provide the patient with a much more "natural" way of seeing. Even though many monovision wearers claim that they are satisfied with their vision, I have never encountered a monovision wearer that didn't want to at least try multifocal lenses and see for themselves.
Other key talking points include less adaptation and more flexibility with multifocal contact lenses versus traditional spectacles. With regard to lens adaptation, many patients are concerned that a multifocal contact lens requires a lot of adaptation just like traditional spectacles. Another concern from patients surfaces when patients have had a negative experience with progressive bifocals. Patients are always delighted to hear that they don't have to find the "sweet spot" in the bifocal portion of the multifocal contact lens. The ease of adaptation is a key factor that motivates patients into trying this new technology.
Unlike traditional spectacles, multifocal contact lenses also offer the patient clear vision over the top of their head in addition to down below their eye level. This is a great opportunity to tap into the flexibility of the multifocal technology and mention to the patient specific examples of when they may need clear vision up close over the top of their head. Such examples include hanging Christmas tree decorations, hanging draperies, or painting. It is also beneficial to mention this specifically to individuals who may have occupations requiring clear vision up over the top of their head at near such as pilots or electricians.
Not all patients are keen on trying something new. It has been my experience that the most common reason for reluctance in trying contact lenses is the fear of inserting and removing the contact lens. For these individuals, I find it helpful to stress the benefits of the silicone hydrogel material and mention the improved durability and flexibility of the lens material. Patients find comfort knowing that the lens material is stronger and more durable than its predecessors. The new material really does make a big difference in decreasing the likelihood of tearing lenses. It has been my experience that new wearers and men (who typically are less comfortable touching their eye) do extremely well with the silicone hydrogel material.
Managing patient expectations is one of the most important components to a patient being successful with multifocal contact lenses. It is important for the doctor to discuss visual goals that the patient may have. I always have the patient state one or two visual goals and document their goals in the chart so that I can follow up with them at their progress visit and confirm that the lenses are performing just as I had discussed. In the event that the patient does not have realistic expectations, I discuss what is or is not a realistic visual outcome.
Another factor that is important to mention to the patient is the importance of good, direct light. I like to use the analogy of a professional basketball player running down the court in baseball cleats. Sure, the ball player will be able to play ball, but is going to be limited to how well he can perform because of his equipment. In this sense, multifocal lenses aren't any different. The multifocal lenses will perform very well in good direct lighting. If a patient's vision isn't as good as it should be, my recommendation to them is to always assess their surroundings to determine whether or not lighting is the issue. I also discuss at the dispense of the lenses that it may be necessary to make some adjustments to their work environment such as having a good, direct light at their work station. It is amazing how this very simple 30 second discussion can make a difference when a patient finds themselves in environments with dim lighting.
It is also beneficial to let the patient know that vision typically gets a little bit better after wearing the lenses for a couple of days. A dramatic improvement is generally not seen, but it is very common for vision to become more crisp after wearing the multifocal technology for a couple of days.
There are many factors that can affect the success of a multifocal wearer. Doctors who are very successful at upgrading patients into multifocal lenses will say that communication is the key to a successful multifocal upgrade. As a result, it is extremely important to provide the patient with realistic patient expectations and prepare them for what they can expect during the first week of the upgrade. Preparing the patient and managing the patient's expectations has proven to be the most important factor to ensuring successful, happy multifocal patients within your practice.